Form 40a - Alabama Individual Income Tax Return - 2012 Page 2

1200024A1283

Form 40A (2012)

Page 2

PART I

1 Were you (and your spouse, if married filing jointly) a resident of Alabama for the entire year 2012?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

If you checked no, DO NOT COMPLETE THIS FORM. See “Which Form To File” on page 5 of instructions.

2 Did you file an Alabama income tax return for the year 2011? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

If you checked no, state the reason for not filing.

3 Give name and address of your present employer:

Yourself

General

Your Spouse

Information

4 Your occupation

Spouse’s occupation

•

•

5 Enter the Federal Adjusted Gross Income

$

and Federal Taxable Income

$

as reported on your 2012

All Taxpayers

Must Complete

Federal Individual Income Tax Return.

This Section

•

6 Do you have income which is reported on your Federal return, but not reported on your Alabama return? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

No

If yes, enter source(s) and amount(s) below (other than state income tax refund):

•

Source

Amount

$

•

Source

Amount

$

•

Source

Amount

$

PART II

(4) Did you provide

Dependents:

(2) Dependent’s social security

1a

(3) Dependent’s

more than one-half

(1) First name

Last name

number.

relationship to you.

dependent's support?

•

•

•

Dependents

•

•

b Total number of dependents claimed above . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Do not include

yourself or

2 Amount allowed. (Multiply the total number of dependents claimed on line 1b by the amount from the dependent chart below.)

your spouse

Use the following chart to determine the per-dependent exemption amount:

Amount on Line 7, Page 1

Dependent Exemption

(See page 10)

0 – 20,000

1,000

20,000 – 100,000

500

Over 100,000

300

•

00

Enter amount here and on page 1, line 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2

PART III

Federal

Tax Liability

•

00

1 Enter the Federal Income Tax Liability from worksheet (see instructions) here and on line 9, page 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1

Deduction

PART IV

1 You may donate all or part of your overpayment. (Enter the amount in the appropriate boxes.)

•

00

00

a Senior Services Trust Fund . . . . . . . . . . . . . . . . . . .

k Alabama Breast & Cervical Cancer Program. . . . . . . .

•

00

00

b Alabama Arts Development Fund . . . . . . . . . . . . . .

l Alabama 4-H Club . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

•

00

00

c Alabama Nongame Wildlife Fund . . . . . . . . . . . . . .

m Alabama Organ Center Donor Awareness Fund. . . . .

•

00

00

d Child Abuse Trust Fund . . . . . . . . . . . . . . . . . . . . . .

n Alabama National Guard Foundation Incorporated . .

•

Donation

00

00

e Alabama Veterans Program. . . . . . . . . . . . . . . . . . .

o Cancer Research Institute. . . . . . . . . . . . . . . . . . . . . . . .

Check-offs

•

00

00

f Alabama Indian Children’s Scholarship Fund . . . .

p Alabama Alternative Fuels Fund . . . . . . . . . . . . . . . . . .

•

00

00

g Penny Trust Fund . . . . . . . . . . . . . . . . . . . . . . . . . . .

q Alabama Military Support Foundation . . . . . . . . . . . . . .

•

00

h Foster Care Trust Fund. . . . . . . . . . . . . . . . . . . . . . .

r Alabama Veterinary Medical Foundation

•

00

00

i Mental Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Spay-Neuter Program . . . . . . . . . . . . . . . . . . . . . . . . . . .

•

00

00

j Neighbors Helping Neighbors . . . . . . . . . . . . . . . . .

s Alabama Association of Rescue Squads . . . . . . . . . . .

•

00

2 Total Donations. Add lines 1a, b, c, d, e, f, g, h, i, j, k, l, m, n, o, p, q, r, and s. Enter here and on page 1, line 26 . . . . . . . . . . . . . . . . . . . . . . . .

If an addressed envelope came with your return, please use it and follow the instructions on the envelope. If you do not have one, mail your return to one of the addresses below.

If you are not making a payment, mail your return to:

If you are making a payment, mail your return, Form 40V, and payment to:

WHERE TO

Alabama Department of Revenue

Alabama Department of Revenue

FILE

P. O. Box 327465

P. O. Box 327477

Montgomery, AL 36132-7465

Montgomery, AL 36132-7477

FORM 40A

Mail only your 2012 Form 40A to one of the above addresses. Prior year returns, amended returns, and all other correspondence should be mailed to

Alabama Department of Revenue, P.O. Box 327464, Montgomery, AL 36132-7464.

ADOR